Associations between hypochloremia with in-hospital mortality and vasopressor dependence in patients with septic shock requiring vasopressors
Hypochloremia and mortality/vasopressor dependence in septic shock
DOI:
https://doi.org/10.54205/ccc.v34.279540Keywords:
Hypochloremia, Sepsis, Septic shock, VasopressorAbstract
Background: Hypochloremia is common and has been linked to increased mortality among critically ill patients. However, the pathophysiological role of hypochloremia is insufficiently explored. This study aimed to assess the associations between hypochloremia with in-hospital mortality and vasopressor dependence among patients with septic shock.
Method: A retrospective cohort study was conducted at Khon Kaen Hospital. Patients with septic shock requiring vasopressors were included from July to December 2022 and categorized into three groups based on serum chloride levels prior to vasopressor initiation (up to 72 hours before septic shock diagnosis): hypochloremia (<96 mEq/L), normochloremia (96-105 mEq/L), and hyperchloremia (>105 mEq/L). The primary outcome was a comparison of in-hospital mortality between patients with hypochloremia and normochloremia. Secondary outcomes include vasopressor duration and vasopressor dependence or death at 24, 48, and 72 hours.
Result: Of the 420 patients included, 35.7% were hypochloremic and 52.4% were normochloremic based on baseline serum chloride status. In-hospital mortality was higher in patients with hypochloremia compared with normochloremia (48.7% vs 37.3%; P=0.044). In multivariable analysis (N=373), after adjustment for age, sex, infection source, bacteremia, fluid balance, and baseline bicarbonate status, hypochloremia remained associated with increased mortality (adjusted RR 1.48, 95% CI 1.13-1.96; P=0.005). No significant differences were found in vasopressor duration or vasopressor dependence or death at 24, 48, and 72 hours among the 3 groups.
Conclusion: Hypochloremia was associated with increased in-hospital mortality after multivariable adjustment in patients with septic shock. However, an association between hypochloremia and vasopressor dependence or duration was not demonstrated. Other adverse outcomes of hypochloremia leading to excess mortality should be further explored.
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